Articles: compression-stockings.
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Deep vein thrombosis is associated with a risk of pulmonary embolism and post thrombotic syndrome (PTS). ⋯ The most important therapeutic measure is prompt and adequate anticoagulation with heparin or fondaparinux. Thrombolysis or thrombectomy is only indicated in highly selected severe cases. The risk of PTS can be reduced by immediate ongoing treatment with compression stockings. Prevention of relapse is achieved using vitamin K antagonists with a target INR of 2.0 to 3.0. The duration of anticoagulation should be tailored to the localisation and etiology of the thrombosis, from at least three months to indefinite treatment. The ongoing risk of bleeding secondary to anticoagulation should be reevaluated at regular intervals as a cost-benefit analysis. New anticoagulants for acute and long term treatment will soon be available for clinical use.
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Comment Letter Randomized Controlled Trial
Dabigatran versus enoxaparin after total hip replacement.
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Journal of critical care · Dec 2007
Venous thromboembolism in critical illness in a community intensive care unit.
Venous thromboembolism (VTE) can be a life-threatening complication of critical illness. Venous thromboembolism rates observed depend on the population studied, the screening modality used, and thromboprophylaxis prescribed. Few studies report on the rates of clinically diagnosed VTE in critically ill patients. The purpose of this study was to characterize the incidence of clinically diagnosed VTE, prophylactic strategies used, and diagnostic studies ordered in a critically ill population at a tertiary community intensive care unit (ICU), both during and after their ICU stay. ⋯ The rates of clinically diagnosed VTE rates in critically ill patients are substantial. Venous thromboembolism occurs before, during, and after ICU discharge. Continued vigilance and thromboprophylaxis are warranted across the continuum of critical illness.
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Randomized Controlled Trial
A randomized trial of the Tubulcus multilayer bandaging system in the treatment of extensive venous ulcers.
Venous ulcers are a major health problem because of their high prevalence and associated high cost of care. Compression therapy is the most widely used treatment for this condition. The vast majority of published articles on compression therapy present the results in the treatment of venous ulcers usually up to 15 to 20 cm(2). However, there are no published data in English medical literature on the efficacy of compression therapy in the treatment of extensive venous ulcers (ulcers >20 cm(2) of more than 6 months' duration) with regard to healing rate, time to healing, and recurrence rate at 12 months after healing. ⋯ This study suggests that for extensive venous ulceration, multilayer compression therapy with the Tubulcus provides an extremely high healing rate. Compression of more than 30 mm Hg results in decreased ulcer recurrence. However, recurrence cannot be completely avoided.
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Randomized Controlled Trial
Combined use of low-dose bupivacaine, colloid preload and wrapping of the legs for preventing hypotension in spinal anaesthesia for caesarean section.
We tested the hypothesis that using a combination of methods would result in a greater reduction in the incidence of hypotension due to spinal anaesthesia in caesarean sections compared with using each method on its own. A total of 120 patients were randomly allocated to the following four treatment groups: 10 mg bupivacaine 0.5% intrathecally plus 500 ml Ringer lactate solution (group B); 4 mg bupivacaine 0.5% plus 25 mug fentanyl plus 500 ml Ringer lactate solution (group F); 4 mg bupivacaine 0.5% plus 25 mug fentanyl intrathecally plus 500 ml Gelofusine intravenously (group G); and 4 mg bupivacaine 0.5% plus 25 mug fentanyl intrathecally plus 500 ml Gelofusine intravenously plus tight wrapping of the lower extremities with an Esmarch bandage (group E). ⋯ Hypotension was detected in 100% of the patients in group B compared with 70.0%, 46.7% and 23.3% of those in groups F, G and E, respectively. Hypotension was thus reduced by using a combination of several methods.